House Calls: Providing Care Beyond the Office Walls
Interest in home-based primary care is growing as payments increase, technology improves, and the population ages.
Fam Pract Manag. 2021 May-June;28(3):22A-22G.
Author disclosures: no relevant financial affiliations disclosed.
The United States is experiencing a resurgence of home-based primary care (HBPC) after a rapid decline during the last century. Steady growth in physician house calls started with the doubling of house call payment rates in 1998 and a doubling and tripling of domiciliary payment rates in 2006. Other factors include the aging of our society; increased technology that allows X-rays, ultrasounds, electrocardiograms, and lab tests to be done in the home; and new CPT payments that target complex patients such as those who need chronic care management, remote patient monitoring, and advance care planning.
HBPC's value has been demonstrated through improved outcomes and reduced costs for complex patients. Medicare's Independence at Home house call program improved outcomes and decreased costs by $2,000 per patient per year, and the U.S. Department of Veterans Affairs' HBPC program reduced hospital days by 60%, readmissions by 21%, and nursing home use by an astounding 89%.1 The data generated support for HBPC on Capitol Hill, at the Centers for Medicare & Medicaid Services (CMS), from Medicare Advantage plans, and from investors.
More recently, the COVID-19 public health emergency (PHE) brought virtual care into patients' homes in a remarkable way. But telehealth is beyond the scope of this article. Currently, Congressional action is needed to enable telehealth to continue in the home after the PHE.
Still, family physicians can take advantage of the growing support for HBPC. This article outlines steps for adding house calls to an office-based practice. Reasons to do so include the following:
Continuity of care for patients who have difficulty getting to the office, ensuring they are not lost in the system.
Better quality of care, increased time with patients, and improved doctor-patient-caregiver relationships, resulting in increased patient satisfaction scores, increased referrals from family members, increased physician satisfaction, and decreased burnout.
Improved end-of-life care, fulfilling the wishes of the majority of patients who desire to be at home surrounded by loved ones at the time of death.
Improved value-based care performance from superior risk capture, reducing gaps in care, improving quality, and lowering the total cost of care.
Increased reimbursement for complex patient care.
Increased payment, improved technology, and the aging of the population have all contributed to steady growth in physician house calls.
House calls have been shown to improve patient outcomes and decrease costs by $2,000 per patient per year.
When adding house calls to an office-based practice, three ingredients necessary to success are patients, processes, and payments.
1. Cornwell T. House calls are reaching the tipping point — now we need the workforce. J Patient Cent Res Rev. 2019;6(3):188–191.
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